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Stentless Choanal Atresia Repair

Choanal atresia (CA) occurs in roughly 1:5000-7000 live births. It affects females twice as often as males, and occurs bilaterally in roughly 50% of cases. Bilateral choanal atresia (BCA) is typically repaired in the newborn period as soon as the child is medically stable; tracheostomy for BCA alone has been widely abandoned. Unilateral CA repair is often deferred until age 2-3 years. Traditional techniques of endoscopic repair involved placing stents in the nasopharynx traditionally made of cut and shaped endotracheal tubes or silicon tubing stents. Stentless repair offers the advantage of decreased foreign body reaction in the nasopharynx causing granulation and scarring, and involves much less maintenance for families after discharge. In this technique, the procedure is performed endoscopically by opening the atresia bilaterally, drilling out pterygoid bone as needed, and removal of the posterior septum and vomer. Normal mucosa is preserved as much as possible to prevent scarring and restenosis. Postoperatively, babies are empirically treated with reflux medications and a short course of antibiotic and steroid drops in the nose; a second look procedure is recommended 4-6 weeks postop to ensure healing and confirm patency.

Editor Recruited By: Sanjay Parikh, MD, FACS

DOI: http://dx.doi.org/10.17797/6w5u6drd5e

Endoscopic bilateral choanal atresia repair, without stents placed
BIlateral CA repair: within first 7-10 days of life as medically indicated
Known skull base defect with encephalocele; airway obstruction from other sites necessitating tracheostomy
ESS setup; Otologic instruments including Skeeter drill easier to use in the neonatal nose
CT scan of fine cuts through base of skull may be beneficial
Remain medial if drilling pterygoid bone is necessary. Preserve normal mucosa wherever possible. Removal of posterior septum and vomer is mandatory. Be aware of low hanging clivus and skull base in craniofacially abnormal children
Decreased granulation and restenosis by avoiding the foreign body reaction of stents
Bleeding, granulation, restenosis
Bleeding, granulation, restenosis
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